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Cited by 720Sleep and related disordersSleep and Work-Related FatigueObstructive Sleep Apnea Research

Sleep, Health, and Society

Open access
Grandner, Michael A.·2017·Sleep Medicine Clinics
DOI 10.1016/j.jsmc.2016.10.012PMC PMC6203594
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Abstract

Biological needs for sleep are met by engaging in behaviors that are largely influenced by the environment, social norms and demands, and societal influences and pressures. Insufficient sleep duration and sleep disorders such as insomnia and sleep apnea are highly prevalent in the US population. This article outlines some of these downstream factors, including cardiovascular and metabolic disease risk, neurocognitive dysfunction, and mortality, as well as societal factors such as age, sex, race/ethnicity, and socioeconomics. This review also discusses societal factors related to sleep, such as globalization, health disparities, public policy, public safety, and changing patterns of use of technology.

AI snapshot

Written from the paper’s full text.

TL;DR

This review argues that sleep is a biological requirement shaped by social, environmental, and societal forces, and that insufficient sleep is linked to broad health harms. It synthesizes population prevalence, health outcome evidence, and social-ecological/behavioral models to frame sleep as a public health and policy issue.

Key findings

  • Population estimates show substantial short sleep: in NHANES 2007–2008, 6.2% reported <5 hours, 33.78% 5–6 hours, 52.68% 7–8 hours, and 7.38% ≥9 hours per typical weeknight; in 2014 BRFSS (444,306 adults), median prevalence of <7 hours was 35.1% (range 28.4% South Dakota to 43.9% Hawaii), and 11.8% reported ≤5 hours.
  • Sleep disturbances are common and vary by age/sex: 2006 BRFSS (>150,000 residents of 36 states/territories) found sleep disturbance in 13.7%–18.1% of men and 17.7%–25.1% of women; NHANES 2007–2008 found long sleep latency (>30 min) in 18.8%, frequent snoring in 31.5%, and moderate-severe difficulty falling asleep in 7.7%.
  • Health associations include mortality, diabetes, and hypertension: meta-analyses indicate 10%–12% increased mortality risk for short sleep and 30%–38% for long sleep; insufficient sleep is associated with 33% increased incident diabetes; short sleep is associated with 20% increased likelihood of hypertension.
  • Social/behavioral determinants include work, technology, and disparities: work time was the primary determinant of sleep duration, with each hour of delayed work/training start associated with 20 more minutes of sleep; 90% of Americans used an electronic device in the hour before bed; blacks/African Americans had 2.5 times the rate of very short sleep (≤4 hours) and about twice the rate of short sleep (5–6 hours) versus non-Hispanic whites, while Asians/others had 4 times the very short sleep rate.

Methods

  • Design: narrative review and conceptual synthesis; no primary data collection or systematic review protocol is reported in the text.
  • Data/sample: synthesizes population surveys (ATUS, NHIS, NHANES, BRFSS), meta-analyses, laboratory/field studies, and policy literature; examples include BRFSS 2014 (444,306 adults), 2006 BRFSS (>150,000 adults), and NHANES 2007–2008.
  • Main analysis: organizes evidence using a social-ecological model (individual, social, societal levels) and health behavior models (Health Belief Model, Integrated Behavioral Model) to link upstream social influences, sleep, and downstream health/functional outcomes.

Limitations

  • The paper states major limitations: inconsistent sleep assessment methods (self-report, diary, polysomnography, actigraphy disagree; no nationally representative dataset with well-validated sleep duration/quality; inconsistent cutoffs), lack of physiologic sleep measures at the societal level, and complexity of social environments not captured by most studies.
  • The paper also states a lack of interventional studies and empirically supported sleep health interventions, limiting causal inference and community-level recommendations.
  • Evident from the text: as a narrative review, it does not report systematic search, inclusion criteria, or study-quality appraisal, so the synthesis is selective rather than exhaustive.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.jsmc.2016.10.012

Cites

273 of 273 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 242 cited sources checked · 0 supported · 0 flagged

  • Premisereasoning

    Insufficient sleep duration and poor sleep quality have been associated with several adverse health outcomes.

    “Because sleep is involved with many physiologic systems, insufficient sleep duration and poor sleep quality have been associated with several adverse health outcomes.”
    Quote in the paperNot a substantial claim
  • Premisecitation

    Reports of sleep disturbance generally declined with age.

    “Interestingly, reports of sleep disturbance generally declined with age.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Grandner, 2012, Age and sleep disturbances among American men and women: data from the U.S. Behavioral Risk Factor Surveillance System, Sleep

      Not checked in the free run.

  • Premisecitation

    The downstream consequences of insufficient sleep duration and/or inadequate sleep quality are varied and impact many physiologic systems.

    “The downstream consequences of insufficient sleep duration and/or inadequate sleep quality (including sleep disorders and circadian misalignment of sleep) are varied and impact many physiologic systems.”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [12] Watson, 2015, Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society, Sleep

      Not checked in the free run.

    • cites [13] Consensus Conference Panel, 2015, Joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society on the recommended amount of sleep for a healthy adult: methodology and discussion, J Clin Sleep Med source

      Not checked in the free run.

    • cites [14] Consensus Conference Panel, 2015, Joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society on the recommended amount of sleep for a healthy adult: methodology and discussion, Sleep source

      Not checked in the free run.

    • cites [15] Consensus Conference Panel, 2015, Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society, J Clin Sleep Med source

      Not checked in the free run.

    • Rests on an assumption: Sleep is a biological requirement for human life, alongside food, water, and air.
  • Study design and conductnone given

    Population estimates of habitual sleep duration are variable, because few studies used identical methods to derive estimates.

    “Population estimates of habitual sleep duration are variable, because few studies used identical methods to derive estimates.”
    Quote in the paperNot a substantial claim
  • Interpretationnone given

    At least one-third of the population seems to be reporting habitual sleep of 6 hours or less.

    “In general, though, at least one-third of the population seems to be reporting habitual sleep of 6 hours or less.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 32
  • Classified as probably not a substantial claim. 18

  • May combine two claims.

    Interpretationreasoning

    Most attention has been focused on risks associated with short sleep duration, which may be far more prevalent.

    “For this reason, most of the attention has been focused on risks associated with short sleep duration, which may be far more prevalent.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The overall pattern that both short and long sleep are associated with mortality risk has generally remained consistent across studies, although not all studies found this pattern.

    “Taken together, this overall pattern of findings, that both short and long sleep are associated with mortality risk, has generally remained consistent across studies, although not all studies found this pattern.17”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [17] Grandner, 2010, Mortality associated with sleep duration: the evidence, the possible mechanisms, and the future, Sleep Med Rev source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    There is still a lack of clarity on the biological plausibility of the long sleep relationship, although some ideas have been proposed.

    “Also, there is still a lack of clarity on the biological plausibility of the long sleep relationship, although some ideas have been proposed.37,38”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [37] Youngstedt, 2004, Long sleep and mortality: rationale for sleep restriction, Sleep Med Rev source

      Not checked in the free run.

    • cites [38] Grandner, 2007, Who are the long sleepers? Towards an understanding of the mortality relationship, Sleep Med Rev source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The AASM/SRS position statement categorizes effects of insufficient sleep as general health, cardiovascular health, metabolic health, mental health, immunologic health, human performance, cancer, pain, and mortality.

    “The recent position statement from the American Academy of Sleep Medicine and Sleep Research Society12–15 broadly categorizes effects of insufficient sleep as pertaining to the following categories: general health, cardiovascular health, metabolic health, mental health, immunologic health, human performance, cancer, pain, and mortality.”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [12] Watson, 2015, Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society, Sleep

      Not checked in the free run.

    • cites [13] Consensus Conference Panel, 2015, Joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society on the recommended amount of sleep for a healthy adult: methodology and discussion, J Clin Sleep Med source

      Not checked in the free run.

    • cites [14] Consensus Conference Panel, 2015, Joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society on the recommended amount of sleep for a healthy adult: methodology and discussion, Sleep source

      Not checked in the free run.

    • cites [15] Consensus Conference Panel, 2015, Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society, J Clin Sleep Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Sleep disturbances are difficult to measure at the population level.

    “Sleep disturbances are difficult to measure at the population level.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Where we sleep, when we sleep, and with whom we sleep are all important markers or indicators of social status, privilege, and prevailing power relations.

    ““Where we sleep, when we sleep, and with whom we sleep are all important markers or indicators of social status, privilege, and prevailing power relations.”11”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] Williams, 2005

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Sleep is an emergent set of many physiologic processes under primarily neurobiological regulation that impact many physiologic systems.

    “Sleep represents an emergent set of many physiologic processes under primarily neurobiological regulation that impact many physiologic systems.”
    Quote in the paperNot a substantial claim0 of 9 sources checked
    • cites [1] Cajochen, 2010, What keeps us awake?–the role of clocks and hourglasses, light, and melatonin, Int Rev Neurobiol source

      Not checked in the free run.

    • cites [2] Fuller, 2009, Neurobiology of sleep

      Not checked in the free run.

    • cites [3] Mackiewicz, 2008, Molecular mechanisms of sleep and wakefulness, Ann N Y Acad Sci source

      Not checked in the free run.

    • cites [4] Schwartz, 2008, Neurophysiology of sleep and wakefulness: basic science and clinical implications, Curr Neuropharmacol source

      Not checked in the free run.

    • cites [5] Franken, 2013, A role for clock genes in sleep homeostasis, Curr Opin Neurobiol source

      Not checked in the free run.

    • cites [6] Feng, 2012, Clocks, metabolism, and the epigenome, Mol Cell source

      Not checked in the free run.

    • cites [7] Gerstner, 2016, Amyloid-beta induces sleep fragmentation that is rescued by fatty acid binding proteins in Drosophila, J Neurosci Res source

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    • cites [8] Xu, 2015, Basal forebrain circuit for sleep-wake control, Nat Neurosci source

      Not checked in the free run.

    • cites [9] Cox, 2016, Calcium imaging of sleep-wake related neuronal activity in the dorsal pons, Nat Commun source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Sleep is socially driven, dictated by the environment, and subject to interpersonal and societal factors.

    “Because of this, sleep is also socially driven, dictated by the environment, and subject to interpersonal and societal factors.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Sleep is a biological requirement for human life, alongside food, water, and air.
    • Rests on an assumption: Achieving sleep requires the individual to engage in volitional behaviors.

  • May combine two claims.

    Premisecitation

    Two meta-analyses found a 10% to 12% increased risk for short sleep and a 30% to 38% increased risk associated with long sleep duration.

    “Still, their findings were highly consistent, indicating a 10% to 12% increased risk for short sleep and a 30% to 38% increased risk associated with long sleep duration.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [33] Gallicchio, 2009, Sleep duration and mortality: a systematic review and meta-analysis, J Sleep Res source

      Not checked in the free run.

    • cites [34] Cappuccio, 2010, Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies, Sleep source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    Time diaries generally show more sleep than other retrospective reports, perhaps because they may better capture time in bed but not actual sleep.

    “Taken together, the time diaries generally show more sleep than other retrospective reports, perhaps because they may better capture time in bed but not actual sleep.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Laboratory findings show that physiologic sleep loss is associated with diabetes risk factors, including insulin resistance, and other diabetes risk factors, such as increased consumption of unhealthy foods.

    “These studies are supported by laboratory findings that show that physiologic sleep loss is associated with diabetes risk factors, including insulin resistance,53–56 and other diabetes risk factors, such as increased consumption of unhealthy foods.57–59”
    Quote in the paperSubstantial claim0 of 7 sources checked
    • cites [53] Buxton, 2010, Sleep restriction for 1 week reduces insulin sensitivity in healthy men, Diabetes source

      Not checked in the free run.

    • cites [54] Morselli, 2010, Role of sleep duration in the regulation of glucose metabolism and appetite, Best Pract Res Clin Endocrinol Metab source

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    • cites [55] Tasali, 2009, Reduced sleep duration or quality: relationships with insulin resistance and type 2 diabetes, Prog Cardiovasc Dis source

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    • cites [56] Spiegel, 2005, Sleep loss: a novel risk factor for insulin resistance and Type 2 diabetes, J Appl Physiol source

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    • cites [57] Spaeth, 2014, Sex and race differences in caloric intake during sleep restriction in healthy adults, Am J Clin Nutr source

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    • cites [58] Kim, 2011, Eating patterns and nutritional characteristics associated with sleep duration, Public Health Nutr source

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    • cites [59] Nedeltcheva, 2009, Sleep curtailment is accompanied by increased intake of calories from snacks, Am J Clin Nutr source

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  • May combine two claims.

    Premisecitation

    The relationship between sleep duration and obesity is dependent on age, with strongest relationships among younger adults and U-shaped relationships more common in middle-aged adults.

    “First, this relationship is dependent on age, with the strongest relationships among younger adults and U-shaped relationships more common in middle-aged adults.47”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [47] Grandner, 2015, Relationship between sleep duration and body mass index depends on age, Obesity (Silver Spring) source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    There is some evidence that habitual short sleep increases likelihood of cardiovascular events, although meta-analyses do not generally show short sleep to be associated with increased cardiovascular mortality.

    “Regarding cardiovascular endpoints, there is some evidence that habitual short sleep increases likelihood of cardiovascular events,84 although meta-analyses do not generally show short sleep to be associated with increased cardiovascular mortality.33,34,85”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [84] Amagai, 2010, Sleep duration and incidence of cardiovascular events in a Japanese population: the Jichi Medical School cohort study, J Epidemiol

      Not checked in the free run.

    • cites [33] Gallicchio, 2009, Sleep duration and mortality: a systematic review and meta-analysis, J Sleep Res source

      Not checked in the free run.

    • cites [34] Cappuccio, 2010, Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies, Sleep source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    These impairments often become cumulative over time and do not seem to level off even after weeks in a laboratory.

    “Furthermore, these impairments often become cumulative over time90 and do not seem to level off even after weeks in a laboratory.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [90] Van Dongen, 2004, Systematic interindividual differences in neurobehavioral impairment from sleep loss: evidence of trait-like differential vulnerability, Sleep

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  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Real-world sleep may be driven by many of the same factors that drive other health-related behaviors, such as diet and exercise.

    “Real-world sleep may be driven by many of the same factors that drive other health-related behaviors, such as diet and exercise.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Some effects may be rescued with stimulants such as caffeine, but effects on executive function particularly do not seem to be rescued.

    “Although some of these effects may be rescued with stimulants such as caffeine, the effects on executive function particularly do not seem to be rescued.92”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [92] Killgore, 2012, Gambling when sleep deprived: don't bet on stimulants, Chronobiol Int source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    As globalization and technology penetrate society, sleep-related beliefs and practices can change, including longer working hours, shift work, and discouraging naps.

    “As globalization and technology penetrate society, sleep-related beliefs and practices can change, including the provision of longer working hours,113–120 shift work,121–124 and discouraging otherwise culturally appropriate naps.125–127”
    Quote in the paperNot a substantial claim0 of 10 sources checked
    • cites [113] Spurgeon, 1997, Health and safety problems associated with long working hours: a review of the current position, Occup Environ Med source

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    • cites [114] Goto, 2003, Association of health behavior and social role with total mortality among Japanese elders in Okinawa, Japan, Aging Clin Exp Res source

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    • cites [115] Lockley, 2006, When policy meets physiology: the challenge of reducing resident work hours, Clin Orthop Relat Res source

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    • cites [116] Ko, 2007, Association between sleeping hours, working hours and obesity in Hong Kong Chinese: the ‘better health for better Hong Kong’ health promotion campaign, Int J Obes (Lond) source

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    • cites [117] Basner, 2009, Dubious bargain: trading sleep for Leno and Letterman, Sleep source

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    • cites [118] Gangwisch, 2009, All work and no play makes Jack lose sleep. Commentary on Virtanen et al. Long working hours and sleep disturbances: the Whitehall II prospective cohort study. Sleep 2009;32:737–45, Sleep source

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    • cites [119] Virtanen, 2009, Long working hours and sleep disturbances: the Whitehall II prospective cohort study, Sleep source

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    • cites [120] Nakata, 2011, Effects of long work hours and poor sleep characteristics on workplace injury among full-time male employees of small- and medium-scale businesses, J Sleep Res source

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    • cites [121] Mahan, 1990, Sleep reduction in night-shift workers: is it sleep deprivation or a sleep disturbance disorder?, Percept Mot Skills source

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    • cites [122] Rajaratnam, 2001, Health in a 24-h society, Lancet source

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  • May combine two claims.

    Premisecitation

    Ohayon meta-analysis found that with age, polysomnographic total sleep time, sleep efficiency, slow-wave sleep, REM sleep, and REM latency decline, whereas sleep latency, wake after sleep onset, stage 1 sleep, and stage 2 sleep increase.

    “This analysis found that with age, polysomnographic total sleep time, sleep efficiency, slow-wave sleep, rapid eye movement (REM) sleep, and REM latency decline, whereas sleep latency, wake after sleep onset, stage 1 sleep, and stage 2 sleep increase.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [131] Ohayon, 2004, Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan, Sleep source

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  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning

    The role of sleep and health in society is driven by healthy behavior choices.

    “Taken together, the role of sleep and health in society is driven by healthy behavior choices.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    A nationally representative study found that black/African Americans were 60% more likely than non-Hispanic whites to report sleep latency more than 30 minutes, although they (along with Hispanics/Latinos) were less likely to report 'difficulty falling asleep.'

    “A nationally representative study found that black/African Americans were 60% more likely than non-Hispanic whites to report sleep latency more than 30 minutes, although they (along with Hispanics/Latinos) were less likely to report “difficulty falling asleep.”31”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [31] Grandner, 2013, Sleep symptoms, race/ethnicity, and socioeconomic position, J Clin Sleep Med source

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  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    Although sleep is an important factor in overall health, society has incentivized insufficient sleep.

    “Although sleep is an important factor in overall health, society has incentivized insufficient sleep.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Sleep disturbances among parents of infants are associated with increased postpartum depression, increased sleep disturbances among infants, and other adverse outcomes.

    “Sleep disturbances among parents of infants are associated with increased postpartum depression,160–162 increased sleep disturbances among infants, and other adverse outcomes.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [160] Okun, 2011, Changes in sleep quality, but not hormones predict time to postpartum depression recurrence, J Affect Disord source

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    • cites [161] Chang, 2010, Sleep deprivation during pregnancy and maternal and fetal outcomes: is there a relationship?, Sleep Med Rev source

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    • cites [162] Pires, 2010, Sleep impairment during pregnancy: possible implications on mother-infant relationship, Med Hypotheses source

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  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    These beliefs and attitudes are differentially endorsed by racial/ethnic groups, which may underlie sleep difficulties in those populations.

    “These beliefs and attitudes, though, are differentially endorsed by racial/ethnic groups, which may underlie sleep difficulties in those populations.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    After adjusting for demographics, socioeconomics, health variables, and depression, rates of sleep disturbances were more prevalent among women for all age groups between 25 and 69 years old, and rates of daytime tiredness were more common in women for all age groups from 18 to 59 and 75 to 79.

    “Statistically, after adjusting for demographics, socioeconomics, health variables, and depression, rates of sleep disturbances were more prevalent among women for all age groups between 25 and 69 years old and rates of daytime tiredness were more common in women for all age groups from 18 to 59 and 75 to 79.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [29] Grandner, 2012, Age and sleep disturbances among American men and women: data from the U.S. Behavioral Risk Factor Surveillance System, Sleep

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Premisereasoning

    There is evidence that one of the strongest societal determinants of sleep is work.

    “Because of this, there is evidence that one of the strongest societal determinants of sleep is work.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Sleep objectively worsens with age, but subjective dissatisfaction with sleep is not associated with normal aging.

    “Thus, it appears that sleep objectively worsens with age, but that subjective dissatisfaction with sleep is not associated with normal aging.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationreasoning

    These behavioral decisions are largely influenced by beliefs and attitudes about sleep.

    “These behavioral decisions, as described in the models above, are largely influenced by beliefs and attitudes about sleep.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Men are more likely to have obstructive sleep apnea, more likely to have difficulty adhering to sleep apnea treatment, and more likely to die as a result of complications or consequences of sleep apnea.

    “For example, men are more likely to have obstructive sleep apnea,139 are more likely to have difficulty adhering to sleep apnea treatment,165,166 and are more likely to die as a result of complications or consequences of sleep apnea.167”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [139] Peppard, 2013, Increased prevalence of sleep-disordered breathing in adults, Am J Epidemiol source

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    • cites [165] Baron, 2011, Spousal involvement in CPAP adherence among patients with obstructive sleep apnea, Sleep Breath source

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    • cites [166] McDowell, 2011, Spousal involvement and CPAP adherence: a two-way street?, Sleep Breath source

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    • cites [167] Punjabi, 2009, Sleep-disordered breathing and mortality: a prospective cohort study, PLoS Med source

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  • May combine two claims.

    Premisecitation

    Overall, in the general population, women report shorter sleep duration, more sleep symptoms, greater rates of insomnia, and lower rates of sleep apnea.

    “Overall, in the general population, women report shorter sleep duration,150 more sleep symptoms,31 greater rates of insomnia,151 and lower rates of sleep apnea.152”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [150] Whinnery, 2014, Short and long sleep duration associated with race/ethnicity, sociodemographics, and socioeconomic position, Sleep source

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    • cites [31] Grandner, 2013, Sleep symptoms, race/ethnicity, and socioeconomic position, J Clin Sleep Med source

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    • cites [151] Green, 2012, The longitudinal course of insomnia symptoms: inequalities by sex and occupational class among two different age cohorts followed for 20 years in the west of Scotland, Sleep source

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  • May combine two claims.

    Premisecitation

    Residents given more time to sleep were more satisfied with the quality of their life and social functioning.

    “Paradoxically, residents given more time to sleep were more worried about decreases in their quality of work as a result of working less, yet they were more satisfied with the quality of their life and social functioning.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [223] Bilimoria, 2016, National cluster-randomized trial of duty-hour flexibility in surgical training, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    A positive relationship between income and insufficient sleep after adjusting for covariates suggests that money may not buy sleep, but many benefits of income may contribute to healthy sleep.

    “A positive relationship between income and insufficient sleep after adjusting for covariates suggests that money may not buy sleep, but many of the benefits of income may contribute to healthy sleep.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [30] Grandner, 2015, Social and behavioral determinants of perceived insufficient sleep, Front Neurol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Poverty is associated with both shorter sleep duration and worse sleep quality.

    “Several studies have shown that poverty is associated with both shorter sleep duration and worse sleep quality.30”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [30] Grandner, 2015, Social and behavioral determinants of perceived insufficient sleep, Front Neurol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Once the benefits of income are accounted for by statistically covarying education, access to health care, and so forth, associations with income are often nonexistent and may go in the opposite direction.

    “However, once the benefits of income are accounted for (by statistically covarying education, access to health care, and so forth), associations with income are often nonexistent and may go in the opposite direction.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [30] Grandner, 2015, Social and behavioral determinants of perceived insufficient sleep, Front Neurol source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Social interactions, commercial activities, and work responsibilities can impinge on sleep.

    “Because of this, social interactions (such as interactions with friends, family, and even online groups), commercial activities (such as eCommerce and availability of entertainment around the clock on demand), and work responsibilities (such as e-mails outside of business hours and business conducted across the globe) can impinge on sleep.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Most studies do not address the complex nature of social-environmental influences on health.

    “Still, most studies do not address the complex nature of social-environmental influences on health.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    Cutoffs and categories used to describe sleep are often inconsistent across studies; the cutoff for the shortest sleep duration category can be as low as 4 hours or less or as high as 7 hours.

    “Third, cutoffs and categories used to describe sleep are often inconsistent across studies; for example, the cutoff for the shortest sleep duration category can be as low as 4 hours or less or as high as 7 hours.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Despite many adults sleeping between 6 and 7 hours per night, this sleep duration is almost never included in the literature, either because epidemiologic studies categorize at the hour or because laboratory studies try to maximize difference between groups.

    “For example, despite many adults sleeping between 6 and 7 hours per night, this sleep duration is almost never included in the literature, either because epidemiologic studies categorize at the hour (including them in either 6- or 7-hour groups) or because laboratory studies try to maximize difference between groups (usually comparing 8–6, 5, or 4 hours but not between 6 and 7).14”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] Consensus Conference Panel, 2015, Joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society on the recommended amount of sleep for a healthy adult: methodology and discussion, Sleep source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    Short sleepers may comprise individuals who are true short sleepers and need less sleep, those who need more sleep but are able to tolerate less sleep for an extended period, and those who are insufficient sleepers.

    “Short sleepers, for example, may comprise individuals who are “true” short sleepers and need less sleep, those who need more sleep but are able to tolerate less sleep for an extended period of time (“resilient”), and those who are insufficient sleepers.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationnone given

    Many safety-sensitive occupations require healthy sleep for optimal performance.

    “As mentioned above, many safety-sensitive occupations, such as those in transportation, law enforcement, and medicine, require healthy sleep for optimal performance.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Federal Aviation Administration recently issued guidelines to address sleep issues in pilots.

    “The Federal Aviation Administration also recently issued guidelines to address sleep issues in pilots.254”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [254] Federal Aviation Administration, 2015

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    There is a lack of healthy sleep interventions relative to healthy diet or physical activity recommendations.

    “As mentioned above, there is a lack of healthy sleep interventions, relative to healthy diet or physical activity recommendations.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    When a large commercial truck crashes, it causes more damage and a greater likelihood of fatal injury.

    “For example, when a large commercial truck crashes, it causes more damage and a greater likelihood of fatal injury.249,250”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [249] NHTSA, 2011

      Not checked in the free run.

    • cites [250] Strohl, 1998

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Watson and colleagues combined geospatial neighborhood analyses with sleep genetic information to characterize a social-environmental influence on sleep duration.

    “An example of one study that brought these methodologies together is cited by Watson and colleagues,268 who combined geospatial neighborhood analyses with sleep genetic information to characterize a social-environmental influence on sleep duration.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [268] Watson, 2016, Sleep duration and area-level deprivation in twins, Sleep source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    Currently, typing of sleep at the community and population level is frequently based on broad sleep duration groups or sleep symptoms, although these groups can be highly heterogeneous.

    “Currently, typing of sleep at the community and population level is frequently based on broad sleep duration groups (eg, “short sleepers”) or sleep symptoms (“difficulty falling asleep”), although these groups can be highly heterogeneous.”
    Quote in the paperNot a substantial claim
44 of 44

  • The paper relies on this without support.

    Sleep is a biological requirement for human life, alongside food, water, and air.

    “Sleep is a biological requirement for human life, alongside food, water, and air.”

  • The paper relies on this without support.

    Achieving sleep requires the individual to engage in volitional behaviors.

    “Like consumption of food and unlike breathing air, achieving this biological need requires the individual to engage in volitional behaviors.”

  • The paper relies on this without support.

    The social-ecological model is appropriate for understanding sleep.

    “This model may also be appropriate for understanding sleep.”

  • The paper relies on this without support.

    Shift work is related to adverse health outcomes in both laboratory and field studies.

    “The influence of globalization and 24/7 society on sleep behaviors is particularly relevant, because shift work has been repeatedly shown in both laboratory and field studies to be related to adverse health outcomes.”

  • The paper relies on this without support.

    Safety-sensitive professions often institute policies that make healthy sleep difficult.

    “The problem is that these professions often institute policies that make healthy sleep difficult.”

  • The paper relies on this without support.

    Formal regulations for sleep disorders screening and fatigue mitigation among commercial drivers have not yet been passed.

    “In the transportation industry, recommendations by the National Highway Transportation and Safety Administration address the need for sleep disorders screening and fatigue mitigation among commercial drivers,250 although formal regulations have not yet been passed.”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Elevated CRP may underlie the association between deficient sleep and mortality and the association between deficient sleep and increased risk for cardiovascular diseases.

    “may not only underlie the association between deficient sleep and mortality, but also the association between deficient sleep and increased risk for cardiovascular diseases”

    From The Sleep-Immune Crosstalk in Health and Disease (2019) · cites this paper as [213]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Figure 3 is assigned two different models

    Minor

    The paper identifies Fig. 3 as a detailed depiction of upstream social-environmental influences, but later identifies it as a schematic of the Health Belief Model.

1 of 1

Cites

Flagged first, then by citations

20 of the 293 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. Pandey, 2011, Short sleep and dysfunctional beliefs and attitudes toward sleep among black men, Sleep, 34, 261
  2. Sell, 2009, Ethnic differences in sleep-health knowledge, Sleep, 32, A392
  3. Orzech, 2012, Electronic media use within 2 hours of bedtime predicts sleep variables in college students, Sleep, 35, A73

Cited by

Sorted by citations

Related

Authors
Grandner, M. A.
Affiliations
University of Arizona (US)
Corresponding author
Grandner, Michael A.
ORCID
Grandner, Michael A.
Venue
Sleep Medicine Clinics
Publisher
Elsevier BV
Published
2017-03
Volume
12
Issue
1
Pages
1-22
ISSN
1556-407X (ISSN-L)
DOI
10.1016/j.jsmc.2016.10.012
PMC
PMC6203594
OpenAlex
W2567025824
Semantic Scholar
4773898630801d244f045f7e0157024300cd56bd
Cited by
720
References
293
Citations by year
2026: 68 · 2025: 109 · 2024: 110 · 2023: 104 · 2022: 132 · 2021: 75 · 2020: 66 · 2019: 28 · 2018: 16 · 2017: 12
FWCI
2.45
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Sleep Medicine Clinics (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Heart, Lung, and Blood Institute (K23HL110216)
  • National Institute on Minority Health and Health Disparities (R01MD011600)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
Keywords
sleep, sleep duration, sleep disorders, insomnia, sleep apnea, cardiovascular risk, metabolic disease risk, neurocognitive impairment, mortality, health disparities, socioeconomic factors, race and ethnicity, sex differences, aging, globalization, public policy, public safety, technology use
MeSH terms
Humans, Health Knowledge, Attitudes, Practice, Public Health, Sleep, Sleep Wake Disorders, Sociological Factors

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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